I did it. I chose a primary elective C-section. In a culture heavy with pressure for “natural” births – I chose the opposite.

Why?

It’s complicated, but let me try to explain.

Birth IS amazing. I revel in it and always have. It is a huge part of why I chose Obstetrics & Gynecology as a career before switching to Emergency Medicine. As someone who has “caught” a lot of babies, I can honestly say that no birth is the same; each one IS special. No matter how many times you’ve seen it/done it – the moment the baby delivers is always a miracle.

I believe that women are so very strong and that their bodies are ever so capable of bringing life into the world in a completely “non-medical” way. BUT I have also seen birth go so very wrong. I have experienced the pale-faced, cold-sweat fear of every single person in a delivery room when nothing is going as planned: a head that was so beautifully crowning and then doesn’t budge, long labors that produce gray, limp babies – bleeding that will just not stop covering the floor and the bedding in crimson.

I have seen women brought in from home after more than 24 hours of labor with no fetal heart tones and heard their anguished wails of loss. The sound of soul-shattering pain is different from the sound of physical pain. You learn the difference if you spend enough time in the Emergency Department or on a Labor & Delivery floor. Most nurses and doctors are calloused to pain cries, but I still jump when I hear the cry of loss. It makes my heart beat faster and my hair stand on end.

Ina May Gaskin, perhaps the most famous midwife of all time, has written and talked about fear during birth. She educates women about fear preventing the progression of labor and increasing pain. It is a brave thing to choose a natural birth, but I have seen brave natural mothers turn away sound medical advice due to fear of medicine.

There’s a fair amount of fear-inducing material out there about anesthetics and surgery and hospitals. I have had up-close experience with some natural-mamas who resisted necessary C-sections with resolute defiance and then spent their time after birth visiting their previously totally healthy babies in the NICU. Hypoxic-ischemic brain injuries are pretty much one of the most depressing things I can think of. Natural birth proponents rightly teach not to fear the pain of labor, but should also teach not to fear medical intervention.

Trust me, everyone celebrates a good natural birth, but no one can possibly know if that will be your story. Of the women who plan natural births, only some of them will “make it” and deliver without anesthesia. Others will eventually accept an epidural (and often tout its wonders immediately) and some will ultimately go on to have a C-section. It is disheartening that a C-section (or epidural) is sometimes perceived as some kind of failure.

A C-SECTION IS NOT A FAILURE!!

Let’s get really nitty-gritty about this for a second. What makes a successful natural birth more likely?

Smaller babies

bigger pelvic outlets

and higher number of prior successful vaginal deliveries.

Should a woman with a narrow pelvis who grew a healthy 9 pound baby be less proud of her accomplishment than a woman with a gynecoid pelvis who grew a healthy 7 pound baby? Of course not!

Little pelvis + really big baby = probably not going to happen naturally. But there is no reward to be lost or gained from “making it” without interventions. The reward for any good birth is a crying baby.

Ultimately, these are my reasons for electing surgery over nature:

Scheduling was paramount. I was a working mother and as a resident physician, my maternity leave started the first day of my next rotation regardless of whether or not I had a baby. Days waiting for labor would have been days of maternity leave wasted without an infant to bond with and care for.

The odds were not in my favor for an induction. The baby was still floating out of my pelvis and my cervix was “long/thick/closed.” There’s nothing that guarantees a natural birth and for me the absolute least ideal situation was 30 hours of labor followed by a necessary C-section.

I was able to plan and feel much more in control of a completely uncontrollable process.

I’d rather have a scar above my pubic bone than a 4th degree tear (vagina to rectum) any day. I don’t think I need to explain the importance of pooping normally. There is all kinds of literature out there about preventing tears, but the truth is: they happen.

I want to avoid the Depends aisle if I can. There’s some evidence that women who’ve had vaginal births are at higher risk of pelvic floor dysfunction. (Pelvic floor dysfunction is a euphemism for peeing yourself unexpectedly and for having your vagina or uterus ‘fall down/out’ – none of which are desirable things.) See this study out of Johns Hopkins on “Pelvic Floor Disorders 5–10 Years After Vaginal or Cesarean.”

From my perspective, there was less risk of birth trauma for my baby. While there are serious risks with a C-section – they tend to be more for the mother (increased pain, bladder trauma/puncture, post-op infection, etc.) with low risk of infant morbidities like brain/brachial plexus injury.

I knew the only reward for any good birth is a healthy baby.

Two C-sections later I can honestly say that I have no regrets. Both of my children were over 9 pounds with double nuchal cords (their umbilical cords were wrapped around their necks twice). While neither of these things would have absolutely necessitated a section – I am so thankful I didn’t have to be rushed to the OR when things went bad (and they probably would have).

I heard Ina May interviewed about her first delivery (a C-section) and she felt (and still feels) that having a C-section prevented normal bonding and negatively affected her relationship with her daughter forever. Forever is a big word. I just want to go on record that the number of people who would stand by such a statement is incredibly small. My C-sections did not interfere with bonding or nursing for me at all – not even a tiny bit.

I don’t want to paint a perfectly rosy picture of C-Sections. After the first one, I puked violently and wanted to scratch my skin off from the long-acting morphine they put in a spinal. I fought to not have it with my second and subsequently found myself in pain like I had never experienced. In spite of all of this, I honestly have happy memories of my deliveries. I remember the smiles and overall happiness that filled the entire OR suite when they let out their first cries. I remember meeting them and holding them and making small talk about TV shows while they sutured me closed. The births of my children were great births.

I am not advising anyone to choose a C-section, but it was the right choice for me. Natural birth promoters support a woman’s right to make choices about birth. A C-section was my informed choice and I’m proud of my birth stories.

If a C-section was not your initial choice, but you chose it when you needed one to have a healthy baby, you are brave. You got cut open and suffered to bring a new life into the world. Way to go, Mama! Whether your baby is welcomed into the world through your vagina or an abdominal incision, it’s a miracle! Be proud and celebrate!

#everybirthisamiracle

END NOTE:
If you are considering a primary-elective C-section, you may be met with some resistance. My advice is to do your research and be able to articulate your reasons clearly. ACOG had previously endorsed this choice, but has recently updated their position. You can read it here.

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13 Comments

LindsayJune 20, 2015 at 10:36 PM

Thank you so so so much for writing this! People are so hard on me for ultimately choosing a c section. I had lots of factors that made me choose this. My daughter was way late and because of her large size my midwife did not want to induce. I am so happy with my decision, but get so belittled by other moms. Great piece! Thank you so much. So well said!

Language is important. I had to re-read this article to find what you were contesting – – and I found it at the beginning on the second time through… “Having delivered lots of babies…” I can certainly change the language to “having attended a lot of births” or having “caught a lot of babies” – and maybe I will because the tone of this piece is meant to be a celebration of all deliveries (assisted or not) and the empowerment of all birth choices and I wouldn’t want a word choice like this one to get in the way of that.
BUT, I have no problem saying that I had awesome friends (who also happen to be doctors) deliver both of my children. They delivered them right out of my open womb. I was present for every second – an empowered and willing participant in the birth of my children. Doctors delivered them into the world and it is the way I chose…. Of course it was my delivery – and I delivered – but they delivered them to me – healthy and chubby and loud and beautiful… Would you prefer I not give my friends credit for delivering my babies because you think it takes something away from me?? I don’t think it takes anything away from me. In fact – knowing that I had so many people helping me makes me feel more awesome about it – – so incredibly grateful. Are you okay with me feeling this way?

AND – – think about adoptive mothers – – are they any less a mother because they didn’t deliver? Do you want to make women who didn’t deliver naturally feel like less?
This article was in NO WAY meant to take away from brave, powerful natural birth mothers/proponents. I FULLY support their choice and celebrate with them. My goal is to promote a culture where we get rid of the heirarchy of birth stories – with unassisted being at the top and c-sections at the bottom…. This article is meant to be EMPOWERING of all women and their stories. I would hope you wouldn’t want to take away from that.

smittyJune 20, 2015 at 4:36 PM

“Ohhhhh wow, when did you “have” your baby?” Yeaaaa, you “had” your baby!” “I c-a-n-n-o-t wait another day to “have” this baby!” And, then there is this, “What doctor “delivered” your baby?” A male doctor cannot “have” a baby, but he surely can “deliver” a baby! In this blog, Kristin embraces each form of ‘birthing’ and encourages the amazing sisterhood of women –which also includes the women who deliver our babies!

Kristin… thank you so much for posting this. My biggest fear when I was pregnant and going through the birthing classes (aside from worrying that my girl would have a heart defect–which she does) was that I would have to have a c-section. My husband and I talked at length about whether to use an epidural or try to go natural. And then, we found out Ali was breech… sitting in my belly like it was a hammock. She had been that way all along, but everyone said she’d turn. When they decided we’d have a c-section, I was terrified and immediately felt like I was a failure. But you’re right, the best results of any birth is a healthy baby… and she is, for the most part. Thank you for such a well-written and encouraging post for any woman who may be deciding how to bring her little one into the world (or who felt badly for not doing the “natural” thing).

Congrats on Ali! I hope you had a speedy recovery from your section and that you can look back and remember the GOOD parts of your story. Claim them, own them and tell them with pride! I’m not sure if you’re going to have any more, but you will be in the position to choose: VBAC or repeat section – – I support whatever YOU CHOOSE!

CTMarch 27, 2015 at 11:48 AM

Thanks very much for this post. I found your blog via your posts about church (am appreciating those too, by the way) but then stumbled on this and am so appreciative to read it. I had a C-section after a long chain of events and for several weeks I felt like such a failure. I had read a lot of Ina May Gaskin and other natural birth empowering resources, and was not prepared for how disappointed I would be if things didn’t go the way I had envisioned. My baby was born healthy and I am so incredibly grateful for that, but in the weeks following the birth I had trouble being thankful and instead focused on my inability to have the natural birth experience I had wanted. Wish I had read something like this post then.

You are the hero of this story – it’s all how you tell it. Claim it, own it. You are brave, you are powerful, you are good. AND – while you can still have a great birth story if you can see yourself as the hero in it, know that all of us should be much more defined by how we parent than how we became one.

I appreciate your honesty here. I have never had a c-section, but I am a homebirth-loss mom. You are spot-on about the natural birth community swapping fear or birth for fear of medical intervention, which is significantly riskier. I was not in that camp, but unfortunately was delivering under the care of a midwife who had swapped her medical experience and training for the quackery unbeknownst to me. Good job for you using your voice to celebrate HEALTHY birth choice!

Thank you for sharing. I can’t even imagine the heartache you’ve endured. I hope you have family and friends who rallied around you – – and although you can never ever forget – – that you are somehow healing.

Kristin,
I have delivered 3 babies vaginally. I had an epidural with my firstborn and, as I said at the time and still say, “it was the best decision of my life!” My twins came very quickly (2 hours start to finish) and so there was no time for medication. I am very proud of both births. But anyway, the points below are GREAT. They are so rarely said. Thank you for saying these true and wise things.
“I have had up-close experience with some natural-mamas who resist necessary C-sections with resolute defiance and then spend their time after birth visiting their previously totally healthy babies in the NICU. Hypoxic-ischemic brain injuries are pretty much one of the most depressing things I can think of. Natural birth proponents rightly teach not to fear the pain of labor, but should also teach not to fear medical intervention.”

“Let’s get really nitty-gritty on this for a second. What makes a successful natural birth more likely? Smaller babies, bigger pelvic outlets, and higher number of prior successful vaginal deliveries. Should a woman with a narrow pelvis who grew a healthy 9 pound baby be less proud of her accomplishment than a woman with a gynecoid pelvis who grew a healthy 7 pound baby? No, of course not!”